Rob ten Hoedt, Executive Vice President EMEA Region of Medtronic

Medtronic is committed to working with the health community to better leverage technologies and services that improve patient outcomes, integrate care delivery and support the global shift toward value-based healthcare, says Rob ten Hoedt, Medtronic’s Executive Vice President.

Medtronic is committed to working with the health community to better leverage technologies and services that improve patient outcomes, integrate care delivery and support the global shift toward value-based healthcare, says Rob ten Hoedt, Medtronic’s Executive Vice President.

Medtronic is notable for the sheer breadth and scope of its offering – spanning everything from legacy cardiovascular solutions and minimally invasive interventions to restorative therapies and diabetes. Having pioneered the transition from “open surgery” to “minimally invasive interventions,” how would you describe the legacy and influence of Medtronic to date?

Medtronic was founded in 1949 as a medical equipment repair shop by Earl Bakken and his brother-in-law, Palmer Hermundslie. Did these two men set out to change medical technology and the lives of millions of people? No. But they did have a deep moral purpose and an inner drive to use their scientific knowledge and entrepreneurial skills to help others. That spirit — combined with our founders' personal integrity and passion — became our guiding philosophy and, ultimately, the Medtronic Mission. Our first life-changing therapy — a wearable, battery-powered cardiac pacemaker — was the foundation for many more Medtronic therapies that use our electrical stimulation expertise to improve the lives of millions of people. Over the years, we developed additional core technologies, including implantable mechanical devices, drug and biologic delivery devices, and powered and advanced energy surgical instruments. Today, our technologies are used to treat nearly 40 medical conditions.

Which are the core strands of the company’s value-offering today?

At Medtronic, we deliver life-improving innovations. Our core business units currently consist of: the Cardiac and Vascular Group (CVG), the Diabetes Group, the Minimally Invasive Therapies Group (MITG) and the Restorative Therapies Group. With all our core business units, Medtronic spans across 150 countries, including 76 manufacturing sites and 21 lab and research development sites. Medtronic has more than 90,000 employees, including 10,000 engineers and scientists worldwide. Medtronic also annually participates in more than 370 clinical trials and currently has more than 47,000 patents in our portfolio.

As the worlds of pharma and MedTech increasingly converge, to what extent have the company’s capabilities evolved to include combination drug-device products?

Medtronic is a worldwide leader in this space with more than 30 years of experience in targeted drug delivery. Medtronic has evolved to include combination drug-device products in several areas, including targeted drug delivery and the Control Workflow℠.

Targeted drug delivery, also known as intrathecal drug delivery, uses the SynchroMed II infusion system to manage chronic pain, including intractable cancer pain. Unlike oral medications that must be absorbed systemically and cross the blood-brain barrier to reach pain signals, targeted drug delivery interrupts pain pathways at their source in the cerebrospinal fluid and spinal cord. An implanted, programmable pump and catheter release prescribed amounts of pain medication directly into the intrathecal space.

The Control Workflow℠ for targeted drug delivery (TDD) is an approach to help eliminate systemic opioids and provide effective pain relief. The purpose of this workflow is to provide a treatment option for chronic pain using low-dose TDD. The implanted pump stores and dispenses medication inside the body, reducing the opportunity for diversion of the drug, for misuse by individuals who are not prescribed the opioids. Additionally, the physician programmes the pump to deliver a certain amount of medication, allowing more physician control compared to systemic opioid therapy, reducing the opportunity for misuse of prescribed opioids. 

In many respects, the MedTech segment seems to lend itself to a value-based healthcare model in that outcomes for engineered solutions are rather more predictive than for drugs. In this era of skyrocketing public expenditure, rising demand and overstressed budgets, what role has Medtronic been playing in rethinking healthcare pathways so as to achieve more with less? 

Around the globe, governments, insurers, hospitals, physicians, and other caregivers are struggling to address unmet healthcare needs without further increasing costs or inhibiting economic growth. At Medtronic, we are committed to working with the health community to better leverage technologies and services that improve patient outcomes, integrate care delivery, and support the global shift toward value-based healthcare.

Right now, medical technology is paid on the promise of the change of an outcome, but if something goes wrong, and the procedure must be done again, we get paid again – so there is a lack of accountability. Medtronic wants to take accountability for the outcome of the treatment with our devices and technology. What healthcare needs desperately are therapies and care pathways for patients that deliver clinical and economic-value and drive efficient, integrated care. This emphasis on fee-for-value instead of fee-for-service can help better manage patient conditions, control costs, and continue to drive and reward innovations.

At Medtronic, we believe that the technologies we create and the solutions we offer can play an important role in helping care organisations align value, share accountability, and propel healthcare past the fragmented state that exists today. While the role of medical technology in value-based healthcare is only beginning to be defined, and we’re in the early stages of demonstrating how it can be applied, we’re certain it can play a fundamental role in improving healthcare for all.

To what extent has Medtronic managed to position itself as a partner of choice for healthcare providers and payers in terms of helping to rationalise and take costs out of the system? 

The attempts to move towards value-based models are only in the early stages, and many systems, payers and governments are just beginning to learn how to implement value-based care models. However, key trends are emerging, and Medtronic collaborates with the healthcare communities around the world to generate new business models.

Moving to value-based care will require more collaboration and cannot be done in isolation. We believe Medtronic has a unique role to play in the move toward aligned, value-based care, but we know we can do even more by working with others. We have worked closely with healthcare leaders across Europe, Asia, the Americas, and China - and we are partnering with organisations — such as Harvard Business School, The International Consortium of Health Outcomes Measurement (ICHOM) and Boston Consulting Group, to name a few — to realise the potential of value-based healthcare.  A good example of rationalisation is Medtronic’s partnerships with hospitals. Our partnerships with more than 200 hospitals are designed to enhance access to medical technology, lower operating costs and improve patient outcomes.

A couple of years ago, Medtronic partnered with the Imperial College Healthcare NHS Trust in the United Kingdom, a major teaching hospital recognised as a centre of excellence in cardiology and cardiothoracic surgery. By renewing aging equipment in the Cath lab, the examination room for patients with heart diseases, with the most innovative medical technology available and by optimising daily operations, we helped Imperial save an estimated £840,000 in the first year. Similar value creation can be seen at other hospitals we’ve partnered with in other parts of Europe, Canada, Latin America, and the United States. 

What have been Medtronic’s experiences in experimenting with risk-sharing or performance-related business models whereby the company is accountable for the attainment of positive health outcomes? 

One example is our commitment to reduce infections associated with pacemakers. To improve the safety of implanting these lifesaving devices, Medtronic now offers the TYRX absorbable antibacterial envelope — which has been shown to reduce the chances of infection among high-risk patients by 70-100 percent — to hospitals as part of an outcomes-based arrangement. Across multiple regions, we are developing bundled payment arrangements, discussing approaches for outcomes-based data sharing with providers, and working with payer organizations on value-based partnerships and new business models.

One model, Diabeter, a value-based programme in the realm of chronic care, helps patients and providers manage diabetes. Diabeter uses high-tech and high-touch solutions to manage the care of 1,700 children and young adults living with Type 1 diabetes. Our Diabeter clinics use an integrated care approach that puts the patient first, and we’re applying learnings from this model to identify other global geographies with similar challenges to roll it out more broadly. 

The advent of the wearable & implantable devices, big data and the IoT is serving to decentralise the hospital and give rise to new care paradigms such as home care and mobile health. In what ways is Medtronic managing to leverage the ‘digital revolution’ and ‘connected health’ to develop technologies and solutions that help anticipate, adapt and react to patient needs beyond the hospital setting? 

At Medtronic, we’re taking two big approaches to how we use data to help healthcare systems be more efficient and effective in their delivery of care. One is by developing devices that use sensing and AI technology to provide closed loop therapies. The other is leveraging data from various sources to help clinicians create more coordinated care pathways for patients.

The benefits of applying data science to these approaches are three-fold:  Firstly, improved accuracy and precision of care. From earlier detection, to more precise surgery, machine pattern recognition can be used to promote the rapid and accurate reading of medical scans, slides, skin lesions, and much more. Secondly, reduced administrative work. Using natural language processing, for example, can help synthesise notes, improve productivity, efficiency, work flow, accuracy and speed for clinicians. Thirdly, empowered patients. Giving individuals more day-to-day control of their disease can be achieved through algorithmic support and insights based on data gathered by sensors and machine learning.

Chronic conditions such as diabetes, cancer, cardiovascular disease, and chronic pain are the leading causes of death and disability in the US. Chronic disease management (CDM) is complex, requiring an integrated care approach that includes regular screenings, check-ups, ongoing monitoring, and patient education. By applying the power of sensor technology and AI into the latest implantable and wearable devices, and managed care solutions, new Medtronic data-driven technologies are uniquely positioned to help clinicians and patients with CDM. 

What exciting solutions can we expect next?

Additive manufacturing in the industry, alone, is expected to nearly triple by 2021. Navigating this new era of more personalised, precision medicine, Medtronic works with patients and clinicians every day to identify and address unmet needs across the healthcare system.

For example, while many wearables and implanted devices are already smart, connected and controlled by patient input, we expect AI will help them to automatically adapt and anticipate patient needs in the future, providing a new approach to chronic pain management. This could significantly reduce the need for prescription painkillers among certain patient populations — reducing hospital admissions due to overdose and helping address a nationwide opioid crisis that currently costs the US $78.5 billion per year.

With an eye towards managing system costs and improving outcomes, advanced design continues to enhance safety, quality, and durability of products. We already see significant progress in this space, with our minimally invasive tools that help surgeons with early detection and more targeted treatment of conditions like lung cancer and Barrett’s esophagus, a leading predictor of esophageal cancer.

Innovation in the surgical space continues, and in the future, we believe more surgical procedures will be facilitated by robotic, navigational or automated technologies. Research by Cambridge Medical Robotics suggests robotic surgery will grow to five times its present scale by 2025. As more procedures become facilitated by this kind of technology, we see great potential across the care continuum for patients and intend to be a leader in advancing computer-assisted minimally invasive procedures well into the future.

With future healthcare expected to be radically transformed by the introduction of an of array novel approaches – from regenerative medicine & personalised precision treatments to additive manufacturing & augmented reality – how does the company ensure it remains abreast of emerging technologies & ahead in the innovation game? 

Our therapies help two people every second, delivering on our Mission to alleviate pain, restore health and extend life. At Medtronic, we believe patient-focused innovation — and strong partnerships — remain key to an even better, more impactful future.

We envision a day in the near future when capabilities like 3D printing will allow physicians to order customized devices manufactured for specific patients; and training on the latest surgical procedures will happen using augmented reality. Longer term, with the help of our partners, we anticipate a day when chronic disease management becomes effortless for patients, cancer treatment is nothing more than a day procedure, and debilitating heart and brain conditions are not only more treatable, but entirely preventable. 

Medtronic unveiled its much-awaited Hugo system earlier this year to much fanfare and has been placing strategic bets of robotics with the acquisition of companies like Mazor X. What is the potential for robotics to “change the face of surgery” over the next decade? And how will Medtronic be looking to position itself in this segment? 

Robotics will undoubtedly help advance the use and effectiveness of minimally invasive surgery and enable more predictable and precise procedures.

We at Medtronic are focusing on helping surgeons restore health and provide the best possible outcomes for their patients. One way we do this is by advancing Minimally Invasive Surgery.

As a leader and partner in surgical instrumentation, we know that technology plays an important role in the continued evolution of surgical care. We are committed to investing in and developing integrated surgical solutions – including robotics – that will bring the benefits of Minimally Invasive Surgery to more patients around the world. We believe that robotic assisted surgery systems founded on surgeons’ and patients’ needs is a platform for future innovation in areas such as data and analytics. That combination of robotic technology and data-based solutions will bring unprecedented value to the operation rooms.

And with regard to integrating artificial intelligence? 

Nothing can replace clinician judgment in patient care, but new data-driven technology in healthcare is helping advance delivery of the right care, to the right patient, at the right time. Sensor technology, artificial intelligence (AI), and machine learning can unlock the potential of data, providing actionable insights to guide clinical decisions. The application of data science, whether built into a device, or leveraged in a managed care offering, may be today’s biggest opportunity for technology to advance chronic disease management — both at an individual patient level and in terms of population health management.